Quantitative gait dysfunction and risk of cognitive decline and dementia

Department of Neurology, Albert Einstein College of Medicine, 1165 Morris Park Avenue, Room 338, Bronx, New York 10461, USA.
Journal of neurology, neurosurgery, and psychiatry (Impact Factor: 6.81). 10/2007; 78(9):929-35. DOI: 10.1136/jnnp.2006.106914
Source: PubMed


Identifying quantitative gait markers of preclinical dementia may lead to new insights into early disease stages, improve diagnostic assessments and identify new preventive strategies.
To examine the relationship of quantitative gait parameters to decline in specific cognitive domains as well as the risk of developing dementia in older adults.
We conducted a prospective cohort study nested within a community based ageing study. Of the 427 subjects aged 70 years and older with quantitative gait assessments, 399 were dementia-free at baseline.
Over 5 years of follow-up (median 2 years), 33 subjects developed dementia. Factor analysis was used to reduce eight baseline quantitative gait parameters to three independent factors representing pace, rhythm and variability. In linear models, a 1 point increase on the rhythm factor was associated with further memory decline (by 107%), whereas the pace factor was associated with decline on executive function measured by the digit symbol substitution (by 29%) and letter fluency (by 92%) tests. In Cox models adjusted for age, sex and education, a 1 point increase on baseline rhythm (hazard ratio (HR) 1.48; 95% CI 1.03 to 2.14) and variability factor scores (HR 1.37; 95% CI 1.05 to 1.78) was associated with increased risk of dementia. The pace factor predicted the risk of developing vascular dementia (HR 1.60; 95% CI 1.06 to 2.41).
Our findings indicate that quantitative gait measures predict future risk of cognitive decline and dementia in initially non-demented older adults.

Download full-text


Available from: Richard Lipton
    • "A more comprehensive gait analysis that moves beyond gait speed, including dynamic metrics of gait (e.g., gait smoothness, regularity, stability; [Lamoth et al., 2011; Ijmker and Lamoth, 2012; Brach et al., 2010]), could increase the specificity of the relationship with future cognitive decline. For example, studies included in the present review showed that pace, rhythm and variability of gait were uniquely related to decline in specific cognitive functions and types of dementia (Verghese et al., 2007). Because comorbidities and other conditions (e.g., low back pain, osteoarthritis, medication) and their detrimental effects on gait speed are common in older adults, dynamic metrics of gait compared with gait velocity might be more sensitive to predict cognitive decline. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Early identification of individuals at risk for cognitive decline may facilitate the selection of those who benefit most from interventions. Current models predicting cognitive decline include neuropsychological and/or biological markers. Additional markers based on walking ability might improve accuracy and specificity of these models because motor and cognitive functions share neuroanatomical structures and psychological processes. We reviewed the relationship between walking ability at one point of (mid)life and cognitive decline at follow-up. A systematic literature search identified 20 longitudinal studies. The average follow-up time was 4.5 years. Gait speed quantified walking ability in most studies (n=18). Additional gait measures (n=4) were step frequency, variability and step-length. Despite methodological weaknesses, results revealed that gait slowing (0.68-1.1 m/sec) preceded cognitive decline and the presence of dementia syndromes (maximal odds and hazard ratios of 10.4 and 11.1, respectively). The results indicate that measures of walking ability could serve as additional markers to predict cognitive decline. However, gait speed alone might lack specificity. We recommend gait analysis, including dynamic gait parameters, in clinical evaluations of patients with suspected cognitive decline. Future studies should focus on examining the specificity and accuracy of various gait characteristics to predict future cognitive decline.
    No preview · Article · Feb 2016 · Ageing research reviews
  • Source
    • "As in our previous studies, global health status (GHS; range 0– 10) was obtained from dichotomous rating (presence or absence) of medical illnesses including: diabetes, chronic heart failure, arthritis, hypertension, depression, stroke, PD, chronic obstructive pulmonary disease, angina, and myocardial infarction (Verghese et al., 2007). Global cognitive status was assessed using the RBANS total score. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Postural instability represents a main source of disability in Parkinsonian syndromes and its pathophysiology is poorly understood. Indirect probes (i.e., mental imagery) of brain involvement support the role of prefrontal cortex as a key cortical region for postural control in older adults with and without Parkinsonian syndromes. Using functional near infrared spectroscopy (fNIRs) as a direct online cortical probe, this study aimed to compare neural activation patterns in prefrontal cortex, postural stability, and their respective interactions, in 1) patients with Parkinsonian syndromes; 2) those with mild parkinsonian signs; 3) and healthy older adults. Among 269 non-demented older adults (76.41±6.70 years, 56% women), 26 individuals presented with Parkinsonian syndromes (Unified Parkinson's disease rating scale (UPDRS): 11.08±3.60), 117 had mild parkinsonian signs (UPDRS: 3.21±2.49), and 126 individuals were included as a healthy control group. Participants were asked to stand upright and count silently for ten seconds while changes in oxygenated hemoglobin levels over prefrontal cortex were measured using fNIRs. We simultaneously evaluated postural stability with center of pressure velocity data recorded on an instrumented walkway. Compared to healthy controls and patients with mild parkinsonian signs, patients with Parkinsonian syndromes demonstrated significantly higher prefrontal oxygenation levels to maintain postural stability. The pattern of brain activation and postural control of participants with mild parkinsonian signs were similar to that of normal controls. These findings highlight the online role of the prefrontal cortex in postural control in patients with Parkinsonian syndromes and afford the opportunity to improve therapeutic options for postural instability.
    Full-text · Article · Nov 2015 · Brain research
  • Source
    • "Identifying and grouping different walking conditions is extremely important in the generation and statistical analysis of representative data given that they will utilize different joint and foot kinematics . Without this function, it is not possible to effectively compare across participants (as in this study) or to longitudinally track individuals for the early identification/screening of neuro-musculoskeletal injury or cognitive decline [1], [2]. Currently, no systems appear to facilitate this. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Within this paper we demonstrate the effectiveness of a novel body-worn gait monitoring and analysis framework to both accurately and automatically assess gait during 'free-living' conditions. Key features of the system include the ability to automatically identify individual steps within specific gait conditions, and the implementation of continuous waveform analysis within an automated system for the generation of temporally normalized data and their statistical comparison across subjects.
    Full-text · Conference Paper · Aug 2015
Show more